SPC365

COMPARISON OF 2-YEARS FOLLOW-UP OF OPTIMAL MEDICAL THERAPY VERSUS BALLOON PULMONARY ANGIOPLASTY FOR INOPERABLE CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: IS IT NOW TIME TO WITHDRAWAL OF ISOLATED MEDICAL THERAPY?

Session: CO 19- Hipertensão Pulmonar
Speaker: Ana Rita Pereira

Congress: CPC 2021
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Ana Rita F. Pereira; Rita Calé; Filipa Ferreira; Sofia Alegria; Daniel Sebaiti; Mariana Martinho; Débora Repolho; Pedro Santos; Sílvia Vitorino; Maria José Loureiro; Hélder Pereira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Cambria"><strong><span style="font-family:Calibri">Introduction: </span></strong><span style="font-family:Calibri">Balloon pulmonary angioplasty (BPA) has emerged as a therapeutic option for chronic thromboembolic pulmonary hypertension (CTEPH) patients (pts) considered ineligible for pulmonary endarterectomy (PEA). The initial publications of the worldwide work-groups showed good short-term outcomes for the technique, but there are limited data regarding medium-term outcomes and its comparison with optimal medical treatment (OMT).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Cambria"><strong><span style="font-family:Calibri">Purpose:</span></strong><span style="font-family:Calibri"> To&nbsp;compare the medium-term outcomes of OMT versus (vs) BPA in inoperable CTEPH.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Cambria"><strong><span style="font-family:Calibri">Methods:</span></strong><span style="font-family:Calibri"> Retrospective single-centre study of consecutive pts with CTEPH followed in a referral centre for Pulmonary Hypertension. Selected those pts considered ineligible for PEA and followed at least 2-years. Comparison between OMT alone [maximum tolerated doses of pulmonary vasodilator drugs (PVD), as indicated] versus BPA (pts who completed the program with or without OMT). Endpoint was a composite of all-cause death and unplanned right heart failure admission at 2-year.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Cambria"><strong><span style="font-family:Calibri">Results:</span></strong><span style="font-family:Calibri"> From 62 pts, 19 pts were included (11 pts were excluded due to recent diagnosis; 32 were submitted to EAP): mean age 65.0&plusmn;15.3 years, 89.5% female. At diagnosis, all pts had functional&nbsp;limitation and elevated serum&nbsp;NTproBNP (median value 1255.0 pg/mL). Mean pulmonary arterial pressure (mPAP) was 46.2&plusmn;9.3 mmHg and pulmonary vascular resistance (PVR) 15.3&plusmn;8.3 Wood units (WU). Concerning treatment, 12 pts (63.2%) underwent OMT alone. These pts had higher NTproBNP levels (<span style="color:black">2670.0 vs 538.0 pg/mL, p&lt;0.01)</span> and PVR (19.7&plusmn;7.6 vs 9.7&plusmn;5.4 WU, p=0.01) and lower CI (1.6&plusmn;0.3 vs 2.4&plusmn;0.5 L/min/m<sup>2</sup>, <span style="color:black">p&lt;0.01)&nbsp;at baseline</span>; the remaining basal features didn&rsquo;t differ among groups (Fig-A). At 2-year follow-up, 71.4% of pts submitted to BPA were under PVD with a mean of 1&plusmn;0.8 drugs per patient and no difference compared to OMT group (83.3%, 1.7&plusmn;0.9 drugs per patient), although oxygen therapy was higher in medical group (50% vs 0%, p=0.04). A significant overall improvement was observed in BPA group (Table-A): all pts were in functional class I (p&lt;0.01), no one had right ventricular&nbsp;(RV) dysfunction (p&lt;0.01) and mPAP decreased to 25.1&plusmn;6.7 mmHg (p=0.01) and RVP to 2.9&plusmn;0.8 WU (p=0.01). Inversely, no change was observed in pts under OMT alone (p&gt;0.05 in all, Table-A). Endpoint rate was 31.6% with all adverse events occurring in the OMT group (50% vs 0%, p=0.04). After adjustment by Cox regression, no difference in baseline or follow-up features besides treatment influenced the outcome. Kaplan-Meier analysis (Graphic-B) confirmed significant benefit of BPA in 2-year outcome occurrence (long rank 4.6, p=0.03).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Cambria"><strong><span style="font-family:Calibri">Conclusions:</span></strong><span style="font-family:Calibri"> BPA strategy seems to improve medium-term functional capacity, RV function and haemodynamics and decrease oxygen therapy dependence </span><span style="font-family:Calibri">in inoperable CTEPH. Pts under OMT alone </span><span style="font-family:Calibri">have a poor prognosis.</span><span style="font-family:Calibri"> These data encourage the development and implementation of the technique for inoperable CTEPH.</span></span></span></p>